A total of 12 published randomized controlled trials were included in this analysis, most of which included functional testing for the assessment of patients with suspected CAD.

The end points of death plus myocardial infarction (MI), MI alone, cardiac hospitalization, invasive coronary angiography (ICA), and revascularization were not significantly reduced with CCTA. Death plus MI had an odds ratio (OR) of 0.87 (95% CI, 0.68-1.10), MI alone had an OR of 0.75 (95% CI, 0.51-1.09), and cardiac hospitalization had an OR of 0.94 (95% CI, 0.68-1.29).

Trial sequential analysis was performed with an alpha error of 5%, and excluded a 25% relative risk reduction in death plus MI and cardiac hospitalization, as well as a 40% relative risk reduction in MI alone compared with standard care. In addition, CCTA significantly increased the need for ICA (OR, 1.5; 95% CI, 1.31-1.72) and revascularization (OR, 2.06; 95% CI, 1.76-2.41).

Because of the increased need for ICA without a reduction in cardiac events, the researchers concluded that CAD is best diagnosed using clinical and functional assessment.